What really happened in Starkville?

Last week I briefly commented on a study of heart attack (AMI) rates in Starkville, MS that found a 27% reduction in the AMI rate in the three years following the imposition of a smoking ban. Though I was initially dismissive, I decided to email the authors, Dr. Robert McMillen and Dr. Robert Collins, to ask for a copy of the study and to see the data. I expected to find the usual flaws, but what I found was even worse: In truth there is no completed study, the relevant data haven’t even been collected yet, and there are no grounds for concluding that the decline in heart attacks had anything to do with Starkville’s smoking ban.

Journalists covering the story reported that the results came from a study that had just been released. This is understandable, since that is what Mississippi State’s* press release claims:

A Mississippi State study released Monday [Nov. 9] shows a 27 percent decrease in heart attacks among Starkville residents since the city passed a smoking ban in 2006.

The “study” was actually just a two page preliminary report [PDF] that has not been published in a journal or subject to peer review. Nonetheless, in the press release and the report the authors express certainty that the decline is attributable to the smoking ban:

Without spending a dime, the community of Starkville has decreased heart attacks by more than 25% [...]

Current research shows that smoking bans in Starkville have contributed to a 27% reduction in the heart attacks of local residents [...]

There are two flaws that plague studies of heart attack reductions in small cities like Starkville. One is the size of the population, which makes wild fluctuations in the data possible. Starkville’s resident population is just a little over 20,000, so there’s nothing to be done about that. The other flaw is the lack of control groups. AMI rates could be declining for reasons unrelated to smoking bans, so it’s necessary to compare communities with smoking bans to similar communities without them.

Admirably, McMillen and Collins intend to collect data from other Mississippi cities to act as control groups. However they don’t have this data yet. When I wrote to them asking for a copy of the study, all I got was this email from Dr. McMillen:

The results that we released in our 2 page report are preliminary results form a larger study. The study examine AMI admissions from several communities that have passed smoke-free ordinances, as well as communities that have not. The latter will serve as controls for the purpose of comparison. The hospital in Starkville was the first to provide us with AMI admission data. When we have received data from the other communities in our study we will prepare a manuscript that compares AMI admissions before and after the smoke-free laws were enacted in communities with and without smoke-free laws.

Without the data from control groups there is no evidence that the decline was caused by the smoking ban. There’s absolutely no way to know whether the ban deserves complete, partial, or zero credit for the decline, and any statement to the contrary is pure speculation.

[...] from 2000-2002 to 2003-2005, there was a 19.3% decline in heart attack deaths in Mississippi. And from the period 2000-2002 to 2006-2008, there was a 29.2% decline in heart attack deaths in Mississippi.

From 2003 to 2008, heart attack deaths in Mississippi fell by 19.1%. From 2002 to 2008, they fell by 29.4%. And from 2000 to 2008, they fell by more than one-third: by 33.9%.

This demonstrates that heart attacks were declining substantially in the state of Mississippi anyway, even in the absence of a smoking ban. It suggests that if Starkville had not enacted a smoking ban, the study still would have found a very large decline in heart attacks from 2003-2005 to 2006-2008.

On Friday I wrote to McMillen and Collins to ask on what basis they reached their conclusion without having received the data from their control groups:

In the two page report you imply rather strongly that the decline in Starkville’s AMI rate is due to the smoking ban (“Without spending a dime, the community of Starkville has decreased heart attacks by more than 25%…”) (“Current research shows that smoking bans in Starkville have contributed to a 27% reduction in the heart attacks of local residents…”). I am curious to know how you have reached this conclusion without having received the data from control groups, as this seems to go far beyond what one could determine from your preliminary results.

I’ve yet to receive any response from them.

In two of my emails I requested to see the data from Starkville broken down year-by-year. If we are to believe the studies from Pueblo and Helena, the bulk of the decline should have occurred immediately after the ban took effect. It would be useful to know if the same pattern occurred in Starkville. They have yet to release this data.

Collins and McMillen have given their statements a veneer of scientific objectivity without providing the transparency needed to substantiate their claims. This hasn’t stopped them from using their results to push for a statewide smoking ban:

Data from the Mississippi State Department of Health and national figures indicates the state would save an estimated $125 million annually in health care expenses if a legislatively mandated smoking ban was enacted, [Collins] added.

“I plead with the Mississippi Legislature to ban smoking in public places,” Collins said. “Our data reflects the findings of every other community that has looked at what happened when smoking is banned in public venues.”

This is yet another example of what Siegel aptly calls “science by press release.” McMillen and Collins have no basis on which to rest their claims, have not published them in any journal, and haven’t even collected all of their data. Yet because they were critical of tobacco a willing press disseminated their conclusions far and wide without asking difficult questions or consulting critics.

When this study is completed it will be interesting to see what if finds. At that time its results could possibly be informative in the debate over a statewide smoking ban. But to go public with results now, before the data is even collected, is a corruption of science for the pursuit of political ends and unfortunately all too typical for today’s anti-smoking movement.

Comments

Big Tobacco Ally and Erstwhile Researcher, Michael J. McFadden, has just released a new study to a shocked worldwide audience. Dr. McFadden (Ph.D. in Advanced Cobweb Cultivation) announced his two year long analysis of heart attacks in Marysville, Montana ( population: 83 http://en.wikipedia.org/wiki/Marysville,_Montana ), a town that has stubbornly resisted the galactic-wide trend toward smoking bans.

In 2013 the residents of the town of Marysville suffered one heart attack. In 2014, after refusing to implement a smoking ban, the town suffered no heart attacks. Study results compiled and analyzed by Dr. McFadden indicate that smoking evidently cuts the heart attack rate in middle-American populations by a shocking ONE HUNDRED PERCENT!

Unfortunately, Dr. McFadden’s fifteen million dollar research grant from Philip RJ Morris has been slashed to a mere fourteen million for the coming fiscal year so his groundbreaking research efforts have come to a screeching halt. Quoting Paul Wallner of the Medical Society of New Jersey he said, “Everything stops. There is no money.”

Internet pundit Jacob Grier has implied that Dr. McFadden released his study results prematurely. McFadden replied to this scurrilous accusation by saying “Stuff it J!” before flying to his Big Tobacco Mansion in the Bahamas.

On a more serious note, the hyping of “studies” like this is a simple disgrace to science. It’s done for politics and glory and the researchers involved in these things should be ashamed. My point about Marysville is actually quite valid in the real world: there are a heckuva lot of towns out there without smoking bans where the heart attack rate has most definitely dropped drastically in their years of having no smoking bans. There are also most definitely towns out there where the number of heart attacks went up after their implementations.

All that’s needed to discover those towns and write highly publicized studies about them is a few hundred million dollars in grant money to attract researchers: hundreds of them would look at their own town’s statistics and Voila! The outliers would appear and the press releases would roll!

Unfortunately that grant money can’t come from Big Tobacco or the researchers’ reputations would probably be ruined and they might find that schools would refuse to hire them! The penalties for touching Big Tobacco money are increasing in the academic world. So, therefore, we see no such research while at the same time of course we’re seeing lots of the opposite sort.

Most so called studies claiming massive reductions in heart attacks, have been unceremoniously debunked by genuine honest scientists. This one will not be any different. One thing that will be the same of course is that the main stream media will ignore this debunk.

It happened in the UK firstly in Scotland, which claimed a 17% reduction according to research, in year one of the ban. Only for the official NHS figures to show an 8% drop, which was a full 2% less than the average of the previous 10 years without the ban.

In England it was claimed up to a 40% drop, when analysed the research excluded any hospital which showed an increase, put together there was a 2% increase.

To News: Actually, by this point there have been well over a dozen, perhaps even a score of these abominations. Virtually every one of them has been ripped apart easily with even the most elementary examination/analysis. That hasn’t stopped the Antis though: just in the last few months they came out with not one, not two, but THREE distinct and different “meta-analyses” of these things.

Basically they all just took little pieces of garbage, piled them up into one big pile, and then announced that they’d built a Crystal Castle out of all those cracked and smelly peat blocks.

I think Chris Snowdon ( http://www.velvetgloveironfist.com/index.php?page_id=1 ) has done some excellent analysis in this area, and, if you want details on any particular “Instant Heart Attack” study you run across (current or historical) there’s usually a good chance that within a week of its announcment Dr. Michael Siegel will put it up on his blog at:

where you’ll see his own primary analysis of it followed by a dozen to a hundred further comments.

Smoking bans are based on lies and built from garbage. It’s not junk science – it’s worse than that: it’s garbage science. Junk science is just sloppy. Garbage science is science deliberately or extraordinarily incompetently perverted to advance a political goal: it stinks.

Why am I not surprised to see another ‘smoking ban reduced heart attacks’ study debunked? Not to mention, the fact that colleges are increasing the penalties for accepting research money from tobacco companies doesn’t surprise me, especially since antis who work for college health schools are so scared to see their allegations about second hand smoke exposed, and the truth comes out about smoking bans NOT causing any type of decrease in heart attack rates and hospital admissions at all.

Loved your first comment(VERY AMAZING parody of what tired anti groups always do over and over), Michael!

Jacob Grier is a freelance writer, bartender, cocktail consultant, and magician in Portland, Oregon. He writes, eats, and drinks a lot. His articles have appeared in the print or online editions of The Washington Post, The Atlantic, The Daily Beast, The Los Angeles Times, Reason, The Oregonian, and other publications. His book on beer cocktails, Cocktails on Tap, is forthcoming from Stewart, Tabori, and Chang in 2015. [Photo by David L. Reamer.]